钙拮抗剂降压治疗地位进展

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1、钙拮抗剂降压治疗地位进展从循证证据和国际治疗指南的角度影响不同种类降压药物治疗地位的决定因素禁忌症循证医学证据不良反应和治疗持续性效益/费用种族各类降压药物的禁忌症(ESC/ESH,2007)噻嗪类利尿剂痛风代谢综合症、糖耐量减低妊娠-阻滞剂哮喘、外周血管病、代谢综合症糖耐量异常、慢阻肺A-V阻滞(2或3度)运动员和强体力活动者二氢吡啶类CCB——快速性心律失常、心力衰竭非二氢吡啶类CCBA-V阻滞(2或3度)心力衰竭ACEI和ARB妊娠、高血钾症双侧肾动脉狭窄醛固酮拮抗剂肾功能衰竭高血钾症绝对(强制)相对(可能)SBPdifferencebetweenrandomizedg

2、roups(mmHg)Relativeriskofoutcomeevent1.501.251.000.750.500.251.501.251.000.750.500.251.501.251.000.750.500.251.501.251.000.750.500.251.501.251.000.750.500.25StrokeMajorCVDCHDCVDdeathTotalmortality-10-8-6-4-2024-10-8-6-4-2024-10-8-6-4-2024-10-8-6-4-2024-10-8-6-4-2024BP-LoweringTreatmentTrialists(W

3、HO/ISH,2003)BloodPressureLoweringTreatmentTrialists’Collaboration.Lancet.2003;362:1527-1535.0.51.02.0RelativeRiskRR(95%CI)BPDifference(mmHg)FavorsFirstListedFavorsSecondListedMajorCVeventsCVmortalityTotalmortality1.02(0.98,1.07)2/0ACEIvsD/BB1.03(0.95,1.11)2/0ACEIvsD/BB1.00(0.95,1.05)2/0ACEIvsD/B

4、B1.04(0.99,1.08)1/0CAvsD/BB1.05(0.97,1.13)1/0CAvsD/BB0.99(0.95,1.04)1/0CAvsD/BB0.97(0.92,1.03)1/1ACEIvsCA1.03(0.94,1.13)1/1ACEIvsCA1.04(0.98,1.10)1/1ACEIvsCABloodPressureLoweringTreatmentTrialists’Collaboration.Lancet.2003;362:1527-1535.BP-LoweringTreatmentTrialistsComparisonsofDifferentActiveTre

5、atmentsRR(95%CI)FavoursfirstlistedFavourssecondlisted0.51.02.0RelativeRiskBPdifference(mmHg)1.09(1.00,1.18)ACEIvs.D/BB0.93(0.86,1.01)CAvs.D/BB1.12(1.01,1.25)ACEIvs.CA2/01/01/1BPLTT(2003):StrokeComparisonsofdifferentactivetreatmentsBloodPressureLoweringTreatmentTrialists’Collaboration.Lancet.2003;

6、362:1527-1535.0.40.60.81.01.21.40.21.82.015105-5OddsratioforCHDACEI’sALLHATACEIUKPDS39EUROPAPROGRESSPROGRESSComCAMELOTHOPEPEACECAPPPSTOP-2ACEIANBP-2SystolicBPdifferencebetweengroups(mmHg)Verdecchiaetal20050NICSALLHATCCBPREVENTIDNT-2CONVINCEVHASSyst-ChinaSYSTEURCAMELOTSTONENICOLEACTIONNORDILINVEST

7、STOP-2CCBINSIGHT151050-5CCB’sELSARelationshipBetweenOddsRatioforCHDandAchievedBPDifferencesCCBsandCVOutcomesNewMeta-Analysis(ACC,2009)在BPLTT的基础上，纳入了2003年以后发表的临床试验：ACTION,ASCOT-BPLA,CAMELOT,CASE-J,FEVER,INVEST,MOSES,HIC